Nu Tri Report 1

8/3/2019 Nu Tri Report 1

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THERAPEUTIC DIET

Food is essential to life. To sustain life, the nutrients in food must

perform three functions within the body: build tissue, regulate

metabolic processes, and provide a source of energy. A proper diet is

essential to good health. A well-nourished person is more likely to be

well developed, mentally and physically alert, and better able to resist

infectious diseases than one who is not well nourished. Proper diet

creates a healthier person and extends the years of normal bodily

functions. Diet therapy is the application of nutritional science to

promote human health and treat disease.

Nutritional Intervention : Diet Modification

Therapeutic diets are based on a normal, adequate diet that is

modified as necessary to provide for individual requirements. In

general, the therapeutic diet should vary from the individuals diet as

little as possible, unless inadequacies must be remedied.

Modifications of the Normal Diet.

Therapeutic diets may be defined as quantitative and qualitative

modifications of the normal diet. The qualitative diet is an adequate

diet adjusted according to the type of food allowed. The quantitative

diet is calculated with an increase or decrease in the amount of the

food constituents.

The adjustment in diet may take any of the following forms :

Change in consistency of foods (liquid diet, soft diet, etc.)

Increase or decrease in energy value of diet (weight - reduction diet

etc.)


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Increase/decrease in type of foods (sodium restricted diet.)

Elimination of specific foods (gluten free diet)

Adjustment in the ratio and balance of proteins, fats (diabetic diet,

renal diet) Rearrangement of the number and frequency of meals (diabetic diet)

PREPARING THE PATIENT FOR MEALS

a. As a nurse, your duties may include serving the diet trays at

mealtime. For many patients, mealtime is the high point of the day.

The patients are more apt to have a better appetite, eat more, andenjoy their food more if you prepare them for their meals before the

trays arrive.

(1) Provide for elimination by offering the bedpan or urinal or assisting

the patient to the bathroom.

(2) Assist the patient to wash hands and face as needed.

(3) Create an attractive and pleasant environment for eating. Remove

distracting articles such as an emesis basin or a urinal, and use a

deodorizer to remove unpleasant odors in the room. See that the room

is well lighted and at a comfortable temperature.

(4) Position the patient for the meal. If allowed, elevate the head of the

bed or assist the patient to sit up in a chair.

(5) Clear the overbed table to make room for the diet tray.

a. Avoid treatments such as enemas, dressings, and injections

immediately before and after meals.

STANDARD HOSPITAL DIETS

a. Clear Liquid Diet. This diet is indicated for the postoperative

patient's first feeding when it is necessary to fully ascertain return of


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gastrointestinal function. It may also be used during periods of acute

illness, in cases of food intolerance, and to reduce colon fecal matter

for diagnostic procedures.

(1) The diet is limited to fat-free broth or bouillon, flavored gelatin,

water, fruit drinks without pulp, fruit ice, Popsicles, tea, coffee or

coffee substitutes, and sugar. No cream or creamers are used.

Carbonated beverages may be included when ordered by the

physician; however, they are often contraindicated.

(2) The standard menu mat (DA Form 2902-15R) provides

approximately 1146 calories. This diet is below the recommended

dietary allowances (RDA) for all nutrients tabulated except for Vitamin

C (ascorbic acid). If the patient is to be on clear liquids for an extended

period of time, the portion sizes should be increased or an accepted

enteral formula may be provided.

b. Full Liquid Diet. This diet is used when a patient is unable to chew or

swallow solid food because of extensive oral surgery, facial injuries,

esophageal strictures, and carcinomas of the mouth and esophagus. It

may be used to transition between a clear liquid and a regular diet for

the post-surgical patient.

(1) The diet consists of foods, which are liquid at room or body

temperature, and will easily flow through a straw. Included in the full

liquid diet are all juices, strained soups, thinned, cooked cereals,

custards, ice cream, sherbet, and milk. A high protein beverage is

given at breakfast and between meals. Commercially prepared liquid

supplements may also be used.

(2) The standard menu mat (DA Form 2902-12-R) provides

approximately 2777 calories. This diet is slightly below the RDA in iron

for females, and in niacin for men.


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c. Advanced Full Liquid Diet. This diet may be prescribed to meet the

nutritive requirements of a patient who must receive a full liquid diet

for an extended period of time or who has undergone oral surgery and

must have foods, which can pass through a straw.

(1) The foods permitted are the same as those allowed on the full liquid

diet. The advanced full liquid diet is made more nutritious by the

addition of blended, thinned, and strained meat, potatoes, and

vegetables. High-protein beverages are served with meals and

between meals.

(2) The standard menu mat provides approximately 4028 calories. The

advanced full liquid diet meets the RDA for all nutrients tabulated.

d. Tonsillectomy and Adenoidectomy Cold Liquid Diet. This diet is used

following a tonsillectomy and adenoidectomy (T&A). It is also used

when only fluids or soothing foods in liquid form are tolerated.

(1) The T&A cold liquid diet provides only cold liquids, which are free of

irritants or acid properties. Foods allowed are flavored gelatins, ice

cream, sherbet, and milk. A high protein beverage is served between

meals.

(2) The standard menu mat is DA Form 2902-14-R. The T&A cold liquid

diet does not meet the RDA for niacin and Vitamin A for adult males or

children ages 4 to 10, and is below the RDA for thiamine for children

ages 1 to 4. It does not meet the RDA for iron for any age group.

e. Soft Diet. The soft diet is prescribed for patients unable to tolerate a

regular diet. It is part of the progressive stages of diet therapy after

surgery or during recovery from an acute illness.

(1) The diet consists of solid foods that are prepared without added

black pepper, chili powder, or chili pepper. It does notcontain whole

grain cereals or salads with raw, fresh fruits and vegetables. Serving


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sizes are small to provide a gradual increase in the amount of food

from the liquid diet.

(2) The standard menu mat (DA Form 2902-4-R) provides

approximately 2236 calories. This diet does not meet the RDA in iron

for females or thiamine for males, nor niacin for either males or

females.

f. Dental Soft Diet. This diet is prescribed for patients who are

recovering from extensive oral surgery, have severe gingivitis, have

had multiple extractions, have chewing difficulties because of tooth

loss or other oral condition, or for the very elderly, toothless patient.

(1) The diet is composed of seasoned ground meats, vegetables, and

other foods, which are easily chewed. The individuality of the patient

must not be overlooked when a dental soft diet is prescribed. Many

patients resent being served ground meat.

(2) Standard menu mats available are DA Form 2902-6-R (dental soft

diet) and DA Form 2906-13-R (dental soft, 2000 mg sodium diet). The

dental soft diet does not meet the RDA in thiamin for males, nor iron

for females.

g. Regular Diet. Regular diets are planned to meet the nutritional

needs of adolescents, adults, and geriatric phases of the life span.

(1) The regular diet includes the basic food groups and a variety of

foods. The basic food groups include meat, milk, vegetables, fruits,

bread and cereal, fats, and sweets.

(2) The standard menu mat, DA Form 2901-R (Regular Diet) provides

approximately 3375 calories. The selective menu is developed by each

individual hospital according to patient needs, food availability, and

cost. The regular diet is designed to provide exceptionally generous

amounts of all recognized nutrients and meets or exceeds the RDA for

all nutrients tabulated.


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h. Diabetic Diet. The diabetic diet is indicated in the treatment of the

metabolic disorder diabetes mellitus. This disease results from an

inadequate production or utilization of insulin. The object of treating

the diabetic patient by diet, with or without insulin or oral drugs, is to

prevent hyperglycemia, hypoglycemia, glycosuria, and ketosis.

(1) The diabetic food exchange lists are the basis for a meal planning

system that was designed by a committee of the American Diabetes

Association and The American Dietetic Association. The system lists:

meat exchange, bread exchange, fruit and juice exchange, vegetable

exchange, milk exchange and fat exchange. The number of exchanges

allowed is based upon the doctor's order and the dietitian's

calculations. Each diabetic diet should be individualized to meet the

needs of the patient. The foods in each exchange contain the same

amount of calories, carbohydrate, protein, and fat per portion size.

Patients select from the exchange based upon their preference.

(2) The adequacy and possible deficiencies depend on the calories. A

diet of less than 1200 calories for women and less than 1500 calories

for men would have a great chance of being deficient in some

nutrients.

(3) The goals of the diabetic diet are:

(a) To improve the overall health of the patient by attaining and

maintaining optimum nutrition.

(b) To attain and maintain an ideal body weight.

(c) To provide for the pregnant woman and her fetus: normal physical

growth in the child, adequate nutrition for lactation needs if she

chooses to breast-feed her infant.

(d) To maintain plasma glucose as near the normal physiologic range

as possible.


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(e) To prevent or delay the development and progression of

cardiovascular, renal, retinal, neurologic, and other complications

associated with diabetes.

(f) To modify the diet as necessary for complications of diabetes and

for associated diseases.

i. Liberal Bland Diet. This diet is indicated for any medical condition

requiring treatment for the reduction of gastric secretion, such as

gastric or duodenal ulcers, gastritis, esophagitis, or hiatal hernia.

(1) The diet consists of any variety of regular foods and beverages,

which are prepared or consumed without black pepper, chili powder, or

chili pepper. Chocolate, coffee, tea, caffeine-containing products, and

decaffeinated coffee are not included in the diet. The diet should be as

liberal as possible and individualized to meet the needs of the patient.

Foods, which cause the patient discomfort, should be avoided. Small,

frequent feedings may be prescribed to lower the acidity of the gastric

content and for the physical comfort of the patient.

(2) The standard menu mat, DA Form 2902-1-R, provides 3213 calories.

The liberal bland diet is slightly below the RDA for thiamine and niacin

for men 19 to 22 years of age. It is also below the RDA in iron for

women of all ages.

j. Low Fat Diet. Fat restricted diets may be indicated in diseases of the

liver, gallbladder, or pancreas in which disturbances of the digestion

and absorption of fat may occur (pancreatitis, post-gastrointestinal

surgery, cholelithiasis, and cystic fibrosis).

(1) The diet contains approximately 40 grams of fat from the six

ounces of lean meat, fish, or poultry, one egg and three teaspoons of

butter, margarine, or other allowed fats. Only lean, well-trimmed meats

and skim milk are used. All foods are prepared without fat.


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(2) The standard menu mat, DA Form 2905-R, provides approximately

2168 calories. Caloric content of the diet can be increased by adding

allowable breads, vegetables, fruits, or skim milk. The diet is below the

RDA in iron for males between the ages of 11 and 22 and females 11

through 50 years of age.

k. Sodium Restricted Diet. The purpose of the sodium-restricted diet is

to promote loss of body fluids for patients who are unable to excrete

the element normally because of a pathological condition. The diet is

indicated for the prevention, control, and elimination of edema in

congestive heart failure; cirrhosis of the liver with ascites; renal

disease complicated by either edema or hypertension; when

administration of adrenocorticotrophic hormone (ACTH) or steroids are

prescribed, and for certain endocrine disorders such as Cushing's

disease and hypothyroidism.

(1) The sodium-restricted diets provide a specific sodium level or a

range of sodium. The diet order must indicate the specific sodium level

or range desired either in milligrams (mg) or mill equivalent (mEq).

Terms such as "salt free" and "low sodium" are not sufficient.

(a) All foods on the 500 mg and 1000 mg sodium diets are prepared

without the addition of salt, and foods high in sodium are omitted. The

500 mg sodium diet uses both sodium restricted bread and margarine.

The 1000 mg sodium diet uses sodium restricted margarine and

regular bread. The 2000 mg sodium diet uses regular bread and

margarine, and regular cereal and desserts prepared with sodium.

(b) The standard menu mats, DA Form 2906-1-R (500 mg sodium diet),

DA Form 2906-2-R (1000 mg sodium diet), and DA Form 2906-3-R

(2000 mg sodium diet), provide between 2083 and 2554 calories.

(2) The diets are below the RDA in iron for males ages 11 to 22 and for

females ages 11 to 50. Thiamine is inadequate for males at all levels.

Calcium and niacin are also low for certain diets and ages.


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Low-Residue Diet -- Foods included in this diet are sugar, salt, meat,

egg, fat, milk, and other low fiber foods. The purpose of this diet is to

reduce fiber to help treat patients with colon problems

High-Fiber Diet -- A high-fiber diet helps patients digest food easily

and provide water in the colon. It prevents trauma of the colon's

linings. High-fiber foods include whole grains, raw fruits, and

vegetables.

Gluten-free Diet -- This diet is prescribed to patients with

malabsorption problems such as celiac disease. Gluten is a kind of

protein found in wheat. Foods which cannot be taken are wheat,

barley, rye, oats and the likes.

Lactose-free Diet -- This diet is prescribed to patients or healthy

people who are lactose-intolerant. Lactose foods like milk and cheese

cannot be metabolized by their bodies. Anything dairy is not allowed.

Low Cholesterol Diet -- This type of diet lowers the cholesterol levels

in the body to decrease possibility of fatty blockages in arteries. Foods

that can be taken in are lean meats, fish, fruits, vegetables, and low-fat

milk.

Low Purine Diet -- This diet is prescribed to patients with gout or uric

acid kidney stones. Foods with purine help produce uric stones which

are not good for our body. Foods allowed are green leafy vegetables,

cheese, cereals, and eggs.

THE VEGETARIAN

a. Because of the dangers of too much animal protein resulting in

health problems or for ecological reasons, many people have chosen to


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be vegetarians. They do not eat any type of meat. Some vegetarian

diets are stricter than others.

(1) Lacto vegetarians eat plant foods and dairy products. They do not

eat eggs.

(2) Ovo vegetarians eat plant foods and eggs. They do not eat dairy

products.

(3) Lacto-ovo vegetarians eat plant foods, dairy products, and eggs.

(4) Fruitarians consume a diet that consists chiefly of fruits, nuts, olive

oil, and honey. They do not eat any animal products.

(5) Vegans eat only plant foods.

b. The greatest concern in the vegetarian diet is attaining adequate

amounts of complete protein. This is easy in the lacto-ovo vegetarian

diet, but difficult for the vegan. The most efficient protein available is

that found in dairy products, eggs, and fish. Among the sources of

protein that can be used most efficiently by the body, meat actually

ranks third. The second best supply of efficient protein is legumes,

soybeans, nuts, and brown rice.

c. Complete proteins are needed to sustain life and to promote growth.

Incomplete protein sources can be combined to become a complete

protein.

(1) Grain may be combined with brewer's yeast, with milk and cheese,

with nuts and milk or legumes. Examples are cereal and milk, a peanut

butter sandwich and milk or yogurt, a cheese sandwich; rice cooked in

milk, and baked beans with nut bread.

(2) Grain with dried beans or wheat germ and nuts, grain with egg, and

grain with cheese. Examples are a poached egg on toast, macaroni and

cheese, and a tortilla with cheese.

(3) Beans, legumes (peas, lentils), rice or soybeans (tofu) with milk,

nuts, or eggs.


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d. Vegans should eat at least two of the following at the same meal in

order to provide all essential amino acids:

(1) Grains or nuts and seeds.

(2) Dried beans or tofu.

(3) Wheat germ.

e. Whole-wheat grains and cereals are preferred in vegetarian diets.

Other foods must be added to the protein sources to supply vitamins

and minerals. Vegetarian diets are often deficient in calcium, iron, zinc,

vitamin D, iodine, and riboflavin. Vitamin B12 is probably missing

entirely. Supplements of these substances often need to be taken.

NURSING INTERVENTIONS WHICH HELP THE PATIENT MEET

NUTRITIONAL NEEDS

Mealtime is an important event in the patient's long day and the

patient's diet is an integral part of the total treatment plan. Certain

nursing interventions may help the patient meet his or her nutritional

needs.

a. Consider the patient's food preferences as much as possible.

Encourage the patient to fill out the selective menu, so that preferred

foods will be served.

b. Provide the patient with assistance in selecting the appropriate

foods from the menu. The use of selective menus has improved food

acceptance in most hospitals.

c. Order and deliver the patient's tray promptly when it has been

delayed while he was undergoing tests or procedures.


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d. Feed or assist the patient as necessary. Even patients, who can feed

themselves, may need assistance in opening milk cartons, cutting

meat, and spreading butter on bread.

e. Discuss the advantages of following the diet. Explain to the patient

why he will feel better and heal faster. For some diseases or disorders,

the patient may be required to follow a special diet during the period of

illness or the remainder of his life.

(1) A high protein diet is essential to repair tissues in any condition,

which involves healing, such as recovery from surgery or burns.

(2) A person with diabetes must adhere to a diet controlled in calories,

carbohydrates, protein, and fat.

(3) A person with hypertension may require a diet restricted in sodium.

f. Inform the dietitian or food service specialist of any special needs the

patient may have. A patient who has lost his teeth and has difficulty

chewing will need modifications in the consistency of the food he eats.

g. Visit with the patient briefly when serving the food tray.

h. Encourage family members to visit during mealtime. If present, a

family member may want to feed the patient who needs assistance. Be

sure that this is relaxing and safe for the patient.

i. When conditions allow for it, encourage the ambulatory patient to go

to the dining hall for meals or open curtains in a double room so that

patients may eat together. If the patient must eat alone, turn on the

television or radio.

RESPONSIBILITIES OF THE PRACTICAL NURSE IN RELATION TO DIET

THERAPY

a. The practical nurse should be familiar with the diet prescription and

its therapeutic purpose. Although individual trays are carefully checked

before leaving the Nutrition Care Division, mistakes can happen.


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Examine each tray with the patient's specific diet in mind. You should

be able to recognize each type of diet.

b. You should relate the diet to body function and the condition being

treated. For example, a low fat diet is usually the first step in treating

patients with elevated blood lipids (hyperlipidemia). Hyperlipidemia

may be caused by improper diet or it may have a secondary cause,

such as hypothyroidism or renal failure. Untreated hyperlipidemia can

lead to coronary heart disease.

c. Be able to explain the general principles of the diet to the patient,

and obtain the patient's cooperation.

(1) For example, teach a diabetic patient the relationship between his

insulin and the amount of food consumed.

(2) Observe the patient's reaction to the diet. If the patient

understands the relationship between his condition and his diet, and is

shown that he can continue to enjoy most of his favorite foods, he is

more likely to remain on the diet.

d. Help plan for the patient's continued care.

(1) Most patients are hospitalized only during the acute and early

convalescent phases of their illness so it may be necessary to continue

a special diet at home.

(2) Chronic conditions, such as diabetes or hypertension, require

permanent dietary alterations.

(3) Be aware of the patient's home situation and the problems that the

diet may cause. The patient and his family will have to adjust their

meal plans.

(4) Request a consultation for the patient with the dietitian early in the

hospitalization to allow for instructions and follow-up care.

FACTORS WHICH ALTER A HOSPITALIZED PATIENT'S EATING

PATTERNS


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The meals served in a hospital cannot accommodate all social and

cultural variations in food habits. However, meals can be individualized

to assure that patients are provided with foods that are acceptable to

them, but still within the restrictions of their diet. A meal, no matter

how carefully planned, serves its purpose only if it is eaten. Many

factors alter a patient's eating patterns during hospitalization.

a. The forced menu of available foods.

b. Isolation from family and significant others.

c. Restriction in activity.

d. A forced eating schedule.

FACTORS IN ILLNESS WHICH MAY ALTER FOOD INTAKE

Nutrition plays an important part in a patient's overall condition. A

person who is ill may need help in meeting his basic needs for

adequate nutrition. Certain factors in illness may alter food intake.

a. The disease processes. The patient's ability to ingest food is

dependent upon the condition of his mouth and oral structures, and his

ability to swallow. Impairment of any of these components will interfere

with eating.

b. Drug therapy, which may alter the patient's appetite.

c. Anxiety about his illness.

d. Loneliness.

e. Diet restrictions. In many disease conditions, a special diet is an

important part of therapy. In addition to educating the patient about

the diet, you should help him to adapt to the diet and enjoy the food

that he can have.


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f. Changes in usual activity level. Exercise has been reported to

increase, decrease, or have no effect on food intake. Although food

intake is decreased immediately after exercise, habitual moderate

exercise over a long period of time promotes increased food intake.

REASONS FOR HOSPITALIZED PATIENTS BEING AT RISK OF

MALNUTRITION

a. The effect of the disease on metabolism. Most illnesses and diseases

increase the need for nutrients. For example, one of the first symptoms

of an infectious disease is loss of appetite and decreased tolerances for

food. But, the infection and possible fever increase the metabolic rate

and the actual nutrient requirements.

b. The disease may cause problems with absorption. An abnormality in

either secretion or motility affects not only digestion but also optimal

absorption. Motility is the movement of food through the digestivetract.

(1) Alterations in motility in the esophagus or stomach may result in

symptoms of indigestion and vomiting. Increased motility of the gastric

contents through the small and large intestines results in decreased

absorption and diarrhea.


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(2) Conditions that increase motility of the small intestine primarily

affect absorption.

c. The anxiety and stress of being ill may reduce the patient's appetite.

d. The treatment may cause problems with intake, digestion, or

absorption. The decreased desire to eat may be caused by impaired

ability to taste food because of medication, bloating resulting from

decreased peristalsis in the gastrointestinal tract following surgery, or

nausea resulting from chemotherapy. Withholding food for various tests

and procedures, or restricting the patient's intake may affect his

appetite.

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Nu Tri Report 1